The strong association throughout the developed world between lower levels of individual socioeconomic status (SES) and poorer health outcomes from many diseases including arthritis is well established. Although not yet well studied in arthritis, recent data suggest that community social determinants, e.g., the socioeconomic environment of an individual's neighborhood, may be operant in this regard, as well. It is of considerable interest that the association of community social determinants with health outcomes appears to be independent of an individual's SES, at least in some clinical situations. Both Healthy People 2010 and the National Arthritis Action Plan place high priority on reducing disparities in health outcomes in this country. Development of effective prevention strategies will require a) precise recognition of individual and community variables that are associated with health outcomes and b) evaluation of the putative mediating mechanisms. The long-term goal of the proposed project is to better understand why people of lower SES have poorer arthritis outcomes. The immediate objective of this project is to define the individual and community social characteristics that contribute to arthritis outcomes using a community-based cohort of individuals derived from a family practice network. This objective will be accomplished through the following specific aims: (1) to test for a significant independent relationship between community level SES and prevalence of arthritis; (2) to test for a significant independent relationship between community level SES and health related quality of life in persons with arthritis; and (3) to test hypothesized "individual-in-context" mediators of the relationship between community level SES and arthritis health outcomes. This project could establish whether there are independent significant contextual effects of communities on the prevalence, severity and progression of arthritis. If these associations are found, potential mediators can be explored to establish the bridge between the observation of associations and implementing and designing prevention strategies. The results of these analyses will guide health policies and the focus of prevention strategies, i.e., at the community and/or individual level.